homework help,online homework help,online tutors,online tutoring,research paper help,do my homework,

1. Case Study
Presented By:
Jeremiash N. Dela Cruz
CG 1-C
Presented to:
Mrs. Leila Bautista
CI-MVCH

2. Table of Contents
I. Introduction
II. General Objectives
III. Patient's Profile
IV. History
V. Anatomy of the organ involved
VI. Laboratory Result
VII. Drug Study
VIII. Discharge Planning

3. I. Introduction
My patient is a 93 year old male who is suffering from a Chronic Renal
Parenchynal Disease which is the most common cause of secondary
hypertension (excluding obesity and alcohol abuse), and is responsible
for 2-5% of all cases of hypertension.
Hypertension is high blood pressure. Blood pressure is the force of blood
pushing against the walls of arteries as it flows through them. Arteries are

4. the blood vessels that carry oxygenated blood from the heart to the body's
tissues.
As blood flows through arteries it pushes against the inside of the artery
walls. The more pressure the blood exerts on the artery walls, the higher
the blood pressure will be. The size of small arteries also affects the blood
pressure. When the muscular walls of arteries are relaxed, or dilated, the
pressure of the blood flowing through them is lower than when the artery
walls narrow, or constrict.
Blood pressure is highest when the heart beats to push blood out into the
arteries. When the heart relaxes to fill with blood again, the pressure is at
its lowest point. Blood pressure when the heart beats is called systolic
pressure. Blood pressure when the heart is at rest is called diastolic
pressure. When blood pressure is measured, the systolic pressure is stated
first and the diastolic pressure second. Blood pressure is measured in
millimeters of mercury (mm Hg). For example, if a person's systolic
pressure is 120 and diastolic pressure is 80, it is written as 120/80 mm
Hg. The American Heart Association has long considred blood pressure
less than 140 over 90 normal for adults. However, the National Heart,
Lung, and Blood Institute in Bethesda, Maryland released new clinical
guidelines for blood pressure in 2003, lowering the standard normal
readings. A normal reading was lowered to less than 120 over less than
80.
Hypertension is a major health problem, especially because it has no
symptoms. Many people have hypertension without knowing it. In the
United States, about 50 million people age six and older have high blood
pressure. Hypertension is more common in men than women and in
people over the age of 65 than in younger persons. More than half of all
Americans over the age of 65 have hypertension. It also is more common
in African-Americans than in white Americans.
Hypertension is serious because people with the condition have a higher
risk for heart disease and other medical problems than people with
normal blood pressure. Serious complications can be avoided by getting
regular blood pressure checks and treating hypertension as soon as it is
diagnosed.
If left untreated, hypertension can lead to the following medical
conditions:
• arteriosclerosis, also called atherosclerosis
• heart attack
• stroke

5. • enlarged heart
• kidney damage.
Arteriosclerosis is hardening of the arteries. The walls of arteries have a
layer of muscle and elastic tissue that makes them flexible and able to
dilate and constrict as blood flows through them. High blood pressure can
make the artery walls thicken and harden. When artery walls thicken, the
inside of the blood vessel narrows. Cholesterol and fats are more likely to
build up on the walls of damaged arteries, making them even
narrower. Blood clots also can get trapped in narrowed arteries, blocking
the flow of blood.
Arteries narrowed by arteriosclerosis may not deliver enough blood to
organs and other tissues. Reduced or blocked blood flow to the heart can
cause a heart attack. If an artery to the brain is blocked, a stroke can
result.
Hypertension makes the heart work harder to pump blood through the
body. The extra workload can make the heart muscle thicken and stretch.
When the heart becomes too enlarged it cannot pump enough blood. If
the hypertension is not treated, the heart may fail.
The kidneys remove the body's wastes from the blood. If hypertension
thickens the arteries to the kidneys, less waste can be filtered from the
blood. As the condition worsens, the kidneys fail and wastes build up in
the blood. Dialysis or a kidney transplant are needed when the kidneys
fail. About 25% of people who receive kidney dialysis have kidney
failure caused by hypertension.
Causes and symptoms
Many different actions or situations can normally raise blood pressure.
Physical activity can temporarily raise blood pressure. Stressful situations
can make blood pressure go up. When the stress goes away, blood
pressure usually returns to normal. These temporary increases in blood
pressure are not considered hypertension. A diagnosis of hypertension is
made only when a person has multiple high blood pressure readings over
a period of time.
The cause of hypertension is not known in 90 to 95 percent of the people
who have it. Hypertension without a known cause is called primary or
essential hypertension.
When a person has hypertension caused by another medical condition, it
is called secondary hypertension. Secondary hypertension can be caused

6. by a number of different illnesses. Many people with kidney disorders
have secondary hypertension. The kidneys regulate the balance of salt
and water in the body. If the kidneys cannot rid the body of excess salt
and water, blood pressure goes up. Kidney infections, a narrowing of the
arteries that carry blood to the kidneys, called renal artery stenosis, and
other kidney disorders can disturb the salt and water balance.
Cushing's syndrome and tumors of the pituitary and adrenal glands often
increase levels of the adrenal gland hormones cortisol, adrenalin, and
aldosterone, which can cause hypertension. Other conditions that can
cause hypertension are blood vessel diseases, thyroid gland disorders,
some prescribed drugs, alcoholism, andpregnancy.
Even though the cause of most hypertension is not known, some people
have risk factors that give them a greater chance of getting hypertension.
Many of these risk factors can be changed to lower the chance of
developing hypertension or as part of a treatment program to lower blood
pressure.
Risk factors for hypertension include:
• age over 60
• male sex
• race
• heredity
• salt sensitivity
• obesity
• inactive lifestyle
• heavy alcohol consumption
• use of oral contraceptives
Some risk factors for getting hypertension can be changed, while others
cannot. Age, male sex, and race are risk factors that a person can't do
anything about. Some people inherit a tendency to get hypertension.
People with family members who have hypertension are more likely to
develop it than those whose relatives are not hypertensive. People with
these risk factors can avoid or eliminate the other risk factors to lower

7. their chance of developing hypertension. A 2003 report found that the rise
in incidence of high blood pressure among children is most likely due to
an increase in the number of overweight and obese children and
adolescents.
Diagnosis
Because hypertension doesn't cause symptoms, it is important to have
blood pressure checked regularly. Blood pressure is measured with an
instrument called a sphygmomanometer. A cloth-covered rubber cuff is
wrapped around the upper arm and inflated. When the cuff is inflated, an
artery in the arm is squeezed to momentarily stop the flow of blood.
Then, the air is let out of the cuff while a stethoscope placed over the
artery is used to detect the sound of the blood spurting back through the
artery. This first sound is the systolic pressure, the pressure when the
heart beats. The last sound heard as the rest of the air is released is the
diastolic pressure, the pressure between heart beats. Both sounds are
recorded on the mercury gauge on the sphygmomanometer.
Normal blood pressure is defined by a range of values. Blood pressure
lower than 120/80 mm Hg is considered normal. A number of factors
such as pain, stress or anxiety can cause a temporary increase in blood
pressure. For this reason, hypertension is not diagnosed on one high
blood pressure reading. If a blood pressure reading is 120/80 or higher for
the first time, the physician will have the person return for another blood
pressure check. Diagnosis of hypertension usually is made based on two
or more readings after the first visit.
Systolic hypertension of the elderly is common and is diagnosed when
the diastolic pressure is normal or low, but the systolic is elevated,
e.g.170/70 mm Hg. This condition usually co-exists with hardening of the
arteries (atherosclerosis).
Blood pressure measurements are classified in stages, according to
severity:
• normal blood pressure: less than less than 120/80 mm Hg
• pre-hypertension: 120-129/80-89 mm Hg
• Stage 1 hypertension: 140-159/90-99 mm Hg
• Stage 2 hypertension: at or greater than 160-179/100-109 mm Hg

8. A typical physical examination to evaluate hypertension includes:
• medical and family history
• physical examination
• ophthalmoscopy: Examination of the blood vessels in the eye
• chest x ray
• electrocardiograph (ECG)
• blood and urine tests.
The medical and family history help the physician determine if the patient
has any conditions or disorders that might contribute to or cause the
hypertension. A family history of hypertension might suggest a genetic
predisposition for hypertension.
The physical exam may include several blood pressure readings at
different times and in different positions. The physician uses a
stethoscope to listen to sounds made by the heart and blood flowing
through the arteries. The pulse, reflexes, and height and weight are
checked and recorded. Internal organs are palpated, or felt, to determine if
they are enlarged.
Because hypertension can cause damage to the blood vessels in the eyes,
the eyes may be checked with a instrument called an ophthalmoscope.
The physician will look for thickening, narrowing, or hemorrhages in the
blood vessels.
A chest x ray can detect an enlarged heart, other vascular (heart)
abnormalities, or lung disease.
An electrocardiogram (ECG) measures the electrical activity of the heart.
It can detect if the heart muscle is enlarged and if there is damage to the
heart muscle from blocked arteries.
Urine and blood tests may be done to evaluate health and to detect the
presence of disorders that might cause hypertension.
Treatment
There is no cure for primary hypertension, but blood pressure can almost
always be lowered with the correct treatment. The goal of treatment is to
lower blood pressure to levels that will prevent heart disease and other

9. complications of hypertension. In secondary hypertension, the disease
that is responsible for the hypertension is treated in addition to the
hypertension itself. Successful treatment of the underlying disorder may
cure the secondary hypertension.
Guidelines advise that clinicians work with patients to agree on blood
pressure goals and develop a treatment plan for the individual patient.
Actual combinations of medications and lifestyle changes will vary from
one person to the next. Treatment to lower blood pressure may include
changes in diet, getting regular exercise, and taking antihypertensive
medications. Patients falling into the pre-hypertension range who don't
have damage to the heart or kidneys often are advised to make needed
lifestyle changes only. A 2003 report of a clinical trial showed that adults
with elevated blood pressures lowered them as mush as 38% by making
lifestyle changes and participating in the DASH diet, which encourages
eating more fruit and vegetables.
Lifestyle changes that may reduce blood pressure by about 5 to 10 mm
Hg include:
• reducing salt intake
• reducing fat intake
• losing weight
• getting regular exercise
• quitting smoking
• reducing alcohol consumption
• managing stress
Patients whose blood pressure falls into the Stage 1 hypertension range
may be advised to take antihypertensive medication. Numerous drugs
have been developed to treat hypertension. The choice of medication will
depend on the stage of hypertension, side effects, other medical
conditions the patient may have, and other medicines the patient is taking.
If treatment with a single medicine fails to lower blood pressure enough,
a different medicine may be tried or another medicine may be added to
the first. Patients with more severe hypertension may initially be given a
combination of medicines to control their hypertension. Combining

10. antihypertensive medicines with different types of action often controls
blood pressure with smaller doses of each drug than would be needed for
just one.
Antihypertensive medicines fall into several classes of drugs:
• diuretics
• beta-blockers
• calcium channel blockers
• angiotensin converting enzyme inhibitors (ACE inhibitors)
• alpha-blockers
• alpha-beta blockers
• vasodilators
• peripheral acting adrenergic antagonists
• centrally acting agonists
Diuretics help the kidneys eliminate excess salt and water from the body's
tissues and the blood. This helps reduce the swelling caused by fluid
buildup in the tissues. The reduction of fluid dilates the walls of arteries
and lowers blood pressure. New guidelines released in 2003 suggest
diuretics as the first drug of choice for most patients with high blood
pressure and as part of any multi-drug combination.
Beta-blockers lower blood pressure by acting on the nervous system to
slow the heart rate and reduce the force of the heart's contraction. They
are used with caution in patients with heart failure, asthma, diabetes, or
circulation problems in the hands and feet.
Calcium channel blockers block the entry of calcium into muscle cells in
artery walls. Muscle cells need calcium to constrict, so reducing their
calcium keeps them more relaxed and lowers blood pressure.
ACE inhibitors block the production of substances that constrict blood
vessels. They also help reduce the build-up of water and salt in the
tissues. They often are given to patients with heart failure, kidney disease,
or diabetes. ACE inhibitors may be used together with diuretics.

11. Alpha-blockers act on the nervous system to dilate arteries and reduce the
force of the heart's contractions.
Alpha-beta blockers combine the actions of alpha and beta blockers.
Vasodilators act directly on arteries to relax their walls so blood can
move more easily through them. They lower blood pressure rapidly and
are injected in hypertensive emergencies when patients have dangerously
high blood pressure.
Peripheral acting adrenergic antagonists act on the nervous system to
relax arteries and reduce the force of the heart's contractions. They
usually are prescribed together with a diuretic. Peripheral acting
adrenergic antagonists can cause slowed mental function and lethargy.
Centrally acting agonists also act on the nervous system to relax arteries
and slow the heart rate. They are usually used with other antihypertensive
medicines.
Prognosis
There is no cure for hypertension. However, it can be well controlled with
the proper treatment. Therapy with a combination of lifestyle changes and
antihypertensive medicines usually can keep blood pressure at levels that
will not cause damage to the heart or other organs. The key to avoiding
serious complications of hypertension is to detect and treat it before
damage occurs. Because antihypertensive medicines control blood
pressure, but do not cure it, patients must continue taking the medications
to maintain reduced blood pressure levels and avoid complications.
Prevention
Prevention of hypertension centers on avoiding or eliminating known risk
factors. Even persons at risk because of age, race, or sex or those who
have an inherited risk can lower their chance of developing hypertension.
The risk of developing hypertension can be reduced by making the same
changes recommended for treating hypertension:
• reducing salt intake
• reducing fat intake
• losing weight

12. • getting regular exercise
• quitting smoking
• reducing alcohol consumption
• managing stress

13. II. General Objective
To be knowledable about the nature of the sepsis
neonatorum, its diagnosis, its treatment and nursing
responsibilities

14. Specific Goals
 To be familiar with the etiology of disease
 To be aware of the signs and symptoms
 To know the complication of the disease
 To be knowledgable on how to prevent this disease
 To know the treatment
 To know the difference of the disease from the
normal laboratory values
 To assure that nursing implementation must be
given

15. III. Patient's Profile
Name: Telesforo Ugale
Age: 93 years old
Gender: Male
Nationality: Filipino
Religion: Roman Catholic
Civil Status: Married
Place of Admission: Metro Vigan Cooperative
Hospital
Admitting Diagnosis: Hypertension vs
Dyslipidemia

16. IV.History
Patient had been experiencing
dizzyness no headaches (LOC)
Chest Pain or easy Fatiguity
Few hours PTA
Dizziness recurred
But followed by vomitting 3 times

17. Patient Later complained
Abdominal Pain & became weak
Hence rushed to ER for admittion

18. V. Anatomy of the Organ Involved
THE HUMAN HEART

19. The human heart has a mass of between 250 and 350 grams and
is about the size of a fist.[5]
It is enclosed in a double-walled protective sac called
the pericardium.[6]
The superficial part of this sac is called the
fibrous pericardium. This sac protects the heart, anchors its
surrounding structures, and prevents overfilling of the heart with
blood.
The outer wall of the human heart is composed of three layers.
The outer layer is called the epicardium, or visceral pericardium
since it is also the inner wall of the pericardium. The middle layer is
called the myocardiumand is composed of muscle which contracts.
The inner layer is called the endocardium and is in contact with the
blood that the heart pumps. Also, it merges with the inner lining
(endothelium) of blood vessels and covers heart valves.[7]
The human heart has four chambers, two superior atria and two
inferior ventricles. The atria are the receiving chambers and the
ventricles are the discharging chambers.
The pathways of blood through the human heart are part of the
pulmonary and systemic circuits. These pathways include
the tricuspid valve, the mitral valve, the aortic valve, and

20. the pulmonary valve.[8]
The mitral and tricuspid valves are
classified as the atrioventricular (AV) valves. This is because they
are found between the atria and ventricles. The aortic and
pulmonary semi-lunar valves separate the left and right ventricle
from the pulmonary artery and the aorta respectively. These valves
are attached to the chordae tendinae (literally the heartstrings),
which anchors the valves to the papilla muscles of the heart.
The interatrioventricular septum separates the left atrium and
ventricle from the right atrium and ventricle, dividing the heart into
two functionally separate and anatomically distinct units.

21. VI.Drug Study

22. VII. Laboratory Result
Ultra Sound
Right Kidney = 8.4 x 4.4cm (LW)
Left Kidney = 7.1 x 3.9cm (LW)
Irregular Contour
Impression:
-Signs of Chronic Renal Parenchymal Disease
With phyelone phritic changes left
Small cortical cyst and tiny nephrolithasis left
Unremarkable Liver, Gall Bladder pancreas spleen right kidney
urinary bladder Prostate gland and Aorta
Hematology
Hematocrit: 45
Hemoglobin: 146
RBC Count: 4.66
WBC
Segmenters: 72.4
Lymphocytes: 14.8
Monocytes: 7.8
Eosinophils: 0
Basophils: 0
Bands: 0

23. VIII. Discharge Planning
Math homework help
https://www.homeworkping.com/
Math homework help
https://www.homeworkping.com/